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Association of Serum Albumin and Severity of Pulmonary Embolism

Background and Objectives: Inflammation is considered a risk factor for venous thromboembolism. The association between inflammatory markers and the severity of acute pulmonary embolism (APE) has not been explored. Methods: We studied the association between two crude markers of inflammation, serum...

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Autores principales: Omar, Hesham R., Mirsaeidi, Mehdi, Rashad, Rania, Hassaballa, Hatem, Enten, Garett, Helal, Engy, Mangar, Devanand, Camporesi, Enrico M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023373/
https://www.ncbi.nlm.nih.gov/pubmed/31936687
http://dx.doi.org/10.3390/medicina56010026
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author Omar, Hesham R.
Mirsaeidi, Mehdi
Rashad, Rania
Hassaballa, Hatem
Enten, Garett
Helal, Engy
Mangar, Devanand
Camporesi, Enrico M.
author_facet Omar, Hesham R.
Mirsaeidi, Mehdi
Rashad, Rania
Hassaballa, Hatem
Enten, Garett
Helal, Engy
Mangar, Devanand
Camporesi, Enrico M.
author_sort Omar, Hesham R.
collection PubMed
description Background and Objectives: Inflammation is considered a risk factor for venous thromboembolism. The association between inflammatory markers and the severity of acute pulmonary embolism (APE) has not been explored. Methods: We studied the association between two crude markers of inflammation, serum albumin, and red cell distribution width (RDW) and massive versus non-massive APE. Results: Among 552 consecutive cases of CT-angiogram-confirmed APE, a total of 46 cases (8.3%) had massive APE. Despite similar demographics and comorbidities, patients with massive APE had higher frequency of acute kidney injury (P = 0.005), higher lactic acid (P = 0.011), higher troponin (P = 0.001), higher BNP (P < 0.001), higher frequency of RV dilation (P = 0.017) and hypokinesis (P = 0.003), and higher in-hospital mortality (15.2% vs. 2%, P < 0.001). Patients with massive APE had significantly lower albumin level (median (IQR): 2.8 (2.2, 3.0) vs. 3.2 (2.8, 3.6) gm/dL, P < 0.001) and higher RDW (median (IQR): 14.7 (13.8, 17.1) vs. 14.2 (13.3, 15.6), P = 0.006) compared with non-massive APE. ROC curves showed that albumin and RDW had an AUC of 0.750 (P < 0.001) and 0.621 (P = 0.006) in predicting a massive APE, respectively. The optimal cutoff values for albumin and RDW that had the highest combined sensitivity and specificity for predicting APE was ≤3 gm/dL and >14, for albumin and RDW, respectively. Restricted cubic splines showed a significant association between albumin (P = 0.0002) and RDW (P = 0.0446) and the occurrence of massive APE. After adjustment for patients’ age, body mass index, white blood cell count, the requirement of antibiotics during hospitalization, diabetes, RDW, and peak creatinine, serum albumin was independently associated with massive APE (OR 0.234, 95% CI 0.129–0.4242, P < 0.001). Conclusion: low serum albumin is associated with massive APE. This association is likely a proxy for higher inflammatory state in massive compared with non-massive APE.
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spelling pubmed-70233732020-03-12 Association of Serum Albumin and Severity of Pulmonary Embolism Omar, Hesham R. Mirsaeidi, Mehdi Rashad, Rania Hassaballa, Hatem Enten, Garett Helal, Engy Mangar, Devanand Camporesi, Enrico M. Medicina (Kaunas) Article Background and Objectives: Inflammation is considered a risk factor for venous thromboembolism. The association between inflammatory markers and the severity of acute pulmonary embolism (APE) has not been explored. Methods: We studied the association between two crude markers of inflammation, serum albumin, and red cell distribution width (RDW) and massive versus non-massive APE. Results: Among 552 consecutive cases of CT-angiogram-confirmed APE, a total of 46 cases (8.3%) had massive APE. Despite similar demographics and comorbidities, patients with massive APE had higher frequency of acute kidney injury (P = 0.005), higher lactic acid (P = 0.011), higher troponin (P = 0.001), higher BNP (P < 0.001), higher frequency of RV dilation (P = 0.017) and hypokinesis (P = 0.003), and higher in-hospital mortality (15.2% vs. 2%, P < 0.001). Patients with massive APE had significantly lower albumin level (median (IQR): 2.8 (2.2, 3.0) vs. 3.2 (2.8, 3.6) gm/dL, P < 0.001) and higher RDW (median (IQR): 14.7 (13.8, 17.1) vs. 14.2 (13.3, 15.6), P = 0.006) compared with non-massive APE. ROC curves showed that albumin and RDW had an AUC of 0.750 (P < 0.001) and 0.621 (P = 0.006) in predicting a massive APE, respectively. The optimal cutoff values for albumin and RDW that had the highest combined sensitivity and specificity for predicting APE was ≤3 gm/dL and >14, for albumin and RDW, respectively. Restricted cubic splines showed a significant association between albumin (P = 0.0002) and RDW (P = 0.0446) and the occurrence of massive APE. After adjustment for patients’ age, body mass index, white blood cell count, the requirement of antibiotics during hospitalization, diabetes, RDW, and peak creatinine, serum albumin was independently associated with massive APE (OR 0.234, 95% CI 0.129–0.4242, P < 0.001). Conclusion: low serum albumin is associated with massive APE. This association is likely a proxy for higher inflammatory state in massive compared with non-massive APE. MDPI 2020-01-09 /pmc/articles/PMC7023373/ /pubmed/31936687 http://dx.doi.org/10.3390/medicina56010026 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Omar, Hesham R.
Mirsaeidi, Mehdi
Rashad, Rania
Hassaballa, Hatem
Enten, Garett
Helal, Engy
Mangar, Devanand
Camporesi, Enrico M.
Association of Serum Albumin and Severity of Pulmonary Embolism
title Association of Serum Albumin and Severity of Pulmonary Embolism
title_full Association of Serum Albumin and Severity of Pulmonary Embolism
title_fullStr Association of Serum Albumin and Severity of Pulmonary Embolism
title_full_unstemmed Association of Serum Albumin and Severity of Pulmonary Embolism
title_short Association of Serum Albumin and Severity of Pulmonary Embolism
title_sort association of serum albumin and severity of pulmonary embolism
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023373/
https://www.ncbi.nlm.nih.gov/pubmed/31936687
http://dx.doi.org/10.3390/medicina56010026
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